Shot in arm breathes hope into lives of world's most vulnerable

By Sir Gustav Nossal

November 12, 2011 — 3.00am

By the time you reach the end of this article, nine children will have died of pneumonia. Despite its relative obscurity to most Australians as a 21st century problem, pneumonia is still the single leading cause of death globally for children under five.

It is this lack of awareness that makes today, World Pneumonia Day, so vital. Thankfully, however, this third World Pneumonia Day is not simply a time to despair over the alarming statistics.

The good news is that the deadly march of pneumonia can be dramatically slowed through new pneumococcal vaccines. However, current generation pneumococcal vaccines are new and complex and the historical precedent is for such vaccines to reach low-income countries only 10 to 15 years after introduction into industrialised countries.

In fact, because 98.5 per cent of child pneumonia deaths occur in developing nations, you might expect that such a vaccine may not get developed at all, because the financial incentives for pharmaceutical companies in producing such a product are weak. Due to high development costs and market uncertainty, vaccine manufacturers have generally not seen value in creating new products to meet needs in developing countries.

Yet, we can mark World Pneumonia Day knowing that pneumococcal vaccine is already starting to reach the children in developing countries who need it most.

Advertisement

In the past year, pneumococcal vaccine has been rolled out in 16 developing nations, from Nicaragua to Yemen. In Sierra Leonean villages, mothers were queuing to immunise their children just one year after children in the United States began receiving the same vaccine. For the first time in history, vaccines are reaching children in developing countries not far behind them reaching children in high-income countries.

So how is this so? The key has been the the Global Alliance for Vaccines and Immunisation, known as the GAVI Alliance, which pulls together heavy-hitters in the global health field, including the World Health Organisation, UNICEF, the World Bank and the Bill & Melinda Gates Foundation.

The alliance draws on donations from governments - including Australia and others - to create what's called the Advance Market Commitment (AMC).

The Pneumococcal AMC was a pilot program, in which donors committed funds to guarantee the price of vaccines once they were developed. These financial commitments provided vaccine manufacturers with the incentive they needed to invest in research and development and to expand manufacturing capacity. In exchange, companies signed a legally binding commitment to provide the vaccines at a price affordable to developing countries.

By concluding supply agreements at a ceiling price, the AMC reduced market uncertainty, allowing manufacturers to supply vaccines at lower prices. The Pneumococcal AMC was made possible with $US1.5 billion ($1.46 billion) from Italy, the United Kingdom, Canada, Russia, Norway, and the Bill & Melinda Gates Foundation, plus a $US1.3 billion commitment from the Global Alliance for Vaccines and Immunisation.

It is this development that has proven the difference between life-saving vaccines being available to many of the world's children, or to just a small number in the richest nations.

The introduction of the pneumococcal vaccine is now the cornerstone of the GAVI Alliance's ambitious plan to ensure all children have access to life-saving vaccines. But plenty remains to be done.

Immunisation against other diseases such as measles, whooping cough, Hib and influenza also help to reduce pneumonia deaths. Breastfeeding, improved nutrition, the reduction of indoor air pollution and timely access to antibiotics are important interventions too. And many millions of children do not yet receive the pneumococcal vaccine.

But what's happening now will make a huge difference. By 2015, the GAVI Alliance expects 58 countries will have introduced this vaccine into immunisation programs and immunised a further 90 million children.

In addition, this vaccine will do more than prevent pneumonia, because pneumococcal disease also causes pneumococcal meningitis - a nasty condition that leaves a quarter of African children who survive it with lifelong disabilities such as deafness, seizures, mental retardation and motor impairment.

Today should be about recognising that every 20 seconds, pneumonia still takes the life of a child. But it should also be time to reflect that the path forward is now lit.

The GAVI Alliance plan is to ensure all children have equal access to life-saving vaccines. No child should die of a disease we have the tools to prevent.

Sir Gustav Nossal is a research biologist and former Australian of the Year. He served as director of the Walter and Eliza Hall Institute of Medical Research until 1996 and chaired the committee overseeing the WHO's Vaccines and Biologicals Program.